A Comparative Analysis Between Paper-Based and Online Surveys on Parental Attitudes Towards Childhood Vaccinations

Furkan Ates; Ahmad Reza Rezaei; Julia Witkiewicz; Marta Dyszkiewicz; Dawid Lewandowski; Artur Sulik; Kacper Toczyłowski

doi:10.3390/children12091161

A Comparative Analysis Between Paper-Based and Online Surveys on Parental Attitudes Towards Childhood Vaccinations

Children (Basel). 2025 Aug 31;12(9):1161. doi: 10.3390/children12091161.

Authors

Furkan Ates¹, Ahmad Reza Rezaei¹, Julia Witkiewicz¹, Marta Dyszkiewicz¹, Dawid Lewandowski¹, Artur Sulik¹, Kacper Toczyłowski¹

Affiliation

¹ Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.

Abstract

Background/objectives: Survey administration mode may significantly influence responses on polarizing health topics, yet this methodological factor remains understudied in vaccine hesitancy research. Understanding how data collection methods affect parental attitudes toward childhood vaccination is crucial for accurate public health surveillance and intervention design.

Methods: This comparative cross-sectional study examined parental attitudes toward childhood vaccination using both paper-based (n = 487) and online (n = 386) survey administration among 873 parents. This study employed multivariate logistic regression analysis to assess differences between survey modes while controlling for demographic variables.

Results: Key outcomes included general vaccination support, belief in vaccine-autism links, preference for natural immunity, and communication comfort with healthcare providers. Substantial differences emerged between survey modes. Online respondents showed significantly lower vaccination support (61.92% vs. 88.48%, p < 0.001), higher belief in the vaccine-autism link (37.31% vs. 16.77%, p < 0.001), and greater endorsement of natural immunity over vaccination (38.08% vs. 12.50%, p < 0.001). After adjusting for demographics, online respondents had 5 times lower odds of supporting childhood vaccination (OR = 0.20, 95% CI: 0.13-0.30) and nearly 5 times higher odds of preferring natural immunity (OR = 4.67, 95% CI: 3.19-6.95). Online respondents were also less likely to feel comfortable discussing vaccines with healthcare providers (51.0% vs. 72.7%, p < 0.001).

Conclusions: Survey administration mode substantially influences measured parental vaccine attitudes, with online platforms capturing more vaccine-skeptical responses. These findings have critical implications for public health research methodology and suggest that mixed-mode survey designs or statistical adjustments may be necessary to obtain representative population estimates of vaccine hesitancy.

Keywords: childhood vaccination; cognitive bias; digital misinformation; health belief model; parental attitudes; survey methodology; vaccine hesitancy.